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Now back to reality. Once we've passed the tooth-fairy phase of life we all know that things we want come with costs and sacrifices.

Universal health care is a benefit that a large majority of Americans say they want. It would grant Americans some semblance of the kind of peace-of-mind that Canadians and Western Europeans enjoy. We wouldn't have to worry that a job loss would also put our family's health coverage at risk. And on and on.

But expanding health coverage to everyone is going to mean higher taxes in some form as well as other sacrifices, such as enforceable cost controls on the medical establishment and some practical limits on patient medical services. Expensive medical procedures that don't demonstrably work or have about the same outcomes as cheaper methods are going to have to be eliminated from coverage. Drugs too will have to prove their efficacy. Welcome to the age of generics.

Knowing there will be costs and how much Americans hate the thought that lunch may not be free, opponents to health care reform have already launched a "Harry and Louise" style scare campaign. A group called Conservatives for Patients' Rights expects to spend up to $20 million on television ads that feature patients and doctors in Canada and Britain complaining about long waits for surgery or how they couldn't get needed medications under their national health care.

It is designed to make you want to desperately cling to the status quo.

Of course, President Barack Obama isn't suggesting that we adopt a single-payer system like these other countries have — which is too bad in my view. People in the United States seem to like our own single-payer government-run program: Medicare. And as to the poor Canadians who can't get decent medical care? A 2008 Harris poll of how the citizens of 10 developed countries feel about their health care system found the United States dead last, with fully a third of Americans saying our system needs to be completely rebuilt. Meanwhile, Canada's system was third-highest in popularity.

But the folks coordinating the ads don't let the facts stand in their way. It's the same public relations group that gave us "Swift boat."

The founder of Conservatives for P.R. is Rick Scott, who once headed the avaricious Columbia/HCA health care company. In 2000, Forbes magazine described Scott as a man who "bought hospitals by the bucketful and promised to squeeze blood from each one." He made a mint doing so.

In 1997, Scott was ousted from Columbia/HCA when a fraud investigation was initiated. On the Conservatives for P.R. Web site, Scott emphasizes that he himself was "never charged” with wrongdoing. But charges were filed against his former company in four states, including Florida. The firm eventually pleaded guilty to systematically overcharging the government and other fraudulent practices and paid a record $1.7 billion in fines.

Bilking the government at one end, and starving community health at the other, that's the man lecturing the public about the dangers of government-run health care.

Republicans in Congress are positioning themselves in this camp too. They're working from a 28-page attack plan by GOP strategist Frank Luntz, an expert on phrasing political positions for maximum advantage. The plan lays out ways to defeat Obama's health care reforms by painting Democrats as wanting "to put Washington politicians in charge of your health care."

The charge is absurd since Obama's intention is to leave current health insurers in place while offering a government plan as an alternative. But there may be real trouble in holding congressional support together when the new costs and sacrifices necessitated by a $120 billion universal health care plan start coming clear.

That is why this is a plea to all Americans. It's adult time now. In order to provide medical insurance to all, we are going to have to take some medicine ourselves. A universal system will make our nation better and our lives more secure. But it won't be free.